Safety of Single-Dose Primaquine in G6PD-Deficient and G6PD-Normal Males in Mali Without Malaria: An Open-Label, Phase 1, Dose-Adjustment Trial

• Published in: The Journal of infectious diseases 2018-03, Vol.217 (8), p.1298-1308
• Main Authors: Chen, Ingrid, Diawara, Halimatou, Mahamar, Almahamoudou, Sanogo, Koualy, Keita, Sekouba, Kone, Daouda, Diarra, Kalifa, Djimde, Moussa, Keita, Mohamed, Brown, Joelle, Roh, Michelle E, Hwang, Jimee, Pett, Helmi, Murphy, Maxwell, Niemi, Mikko, Greenhouse, Bryan, Bousema, Teun, Gosling, Roly, Dicko, Alassane
• Format: Article
• Language: English
• Subjects: Major and Brief Reports
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jiy014

Abstract Background The World Health Organization recommendation on the use of a single low dose of primaquine (SLD-PQ) to reduce Plasmodium falciparum malaria transmission requires more safety data. Methods We conducted an open-label, nonrandomized, dose-adjustment trial of the safety of 3 single doses of primaquine in glucose-6-phosphate dehydrogenase (G6PD)-deficient adult males in Mali, followed by an assessment of safety in G6PD-deficient boys aged 11–17 years and those aged 5–10 years, including G6PD-normal control groups. The primary outcome was the greatest within-person percentage drop in hemoglobin concentration within 10 days after treatment. Results Fifty-one participants were included in analysis. G6PD-deficient adult males received 0.40, 0.45, or 0.50 mg/kg of SLD-PQ. G6PD-deficient boys received 0.40 mg/kg of SLD-PQ. There was no evidence of symptomatic hemolysis, and adverse events considered related to study drug (n = 4) were mild. The mean largest within-person percentage change in hemoglobin level between days 0 and 10 was −9.7% (95% confidence interval [CI], −13.5% to −5.90%) in G6PD-deficient adults receiving 0.50 mg/kg of SLD-PQ, −11.5% (95% CI, −16.1% to −6.96%) in G6PD-deficient boys aged 11–17 years, and −9.61% (95% CI, −7.59% to −13.9%) in G6PD-deficient boys aged 5–10 years. The lowest hemoglobin concentration at any point during the study was 92 g/L. Conclusion SLD-PQ doses between 0.40 and 0.50 mg/kg were well tolerated in G6PD-deficient males in Mali. Clinical Trials Registration NCT02535767. This phase 1, open-label, nonrandomized, dose-adjustment trial showed that single doses of primaquine between 0.40 and 0.50 mg/kg were well tolerated in G6PD-deficient and G6PD-normal males in Mali, supporting the World Health Organization recommendation on the use of a single low of dose primaquine to reduce Plasmodium falciparum malaria transmission.